It is possible that limited access to health care services
acts a barrier to elective immunizations elsewhere but is less of a factor in Canada, where there is universal access. The main limitation of this study is related to its reliance on self-reported data. This could have potentially introduced some misclassification errors due to poor recall and social desirability. In addition, addressing this survey to adolescents as young as 12 years old may affects the accuracy of the information obtained. Studies which have compared the results of self-response against medical records, however, found that self-report on influenza vaccination is highly sensitive and showed a high degree of agreement  and .
In addition, a significant Akt inhibitor limitation of this study is the lack of available data regarding willingness to pay for the vaccine, which could be a potential barrier to get influenza vaccine. Prosser et al.  suggest that different community members may appraise the desirability or cost-effectiveness of influenza vaccination quite differently, Steiner et al.  found that 1/3 of healthcare workers would refuse vaccination if asked to pay at least $10. In Canada, only Ontario has a free influenza vaccination program for all ages. In reviewing our data, the proportion of youths having received influenza vaccination in the prior year in the province Ontario (38%) was higher than that of the national rate (23%). Although it is PD0325901 possible that universal coverage for influenza vaccination in Ontario may have influenced this differential vaccination uptake, future research should specifically first address the influence of willingness to pay on the
decision to undergo influenza vaccination. Moreover, this is a retrospective analysis of a nationally collected database, we are limited to available variables and data. The follow up questions about reasons for not vaccinating only reflect the respondent’s views, neither reflect that of their parents nor that of their physician, which may influence the respondent to receive influenza vaccine. Illicit drug use, would also affect decision to receive influenza vaccine as another unhealthy habit, but unfortunately, this variable was not available for our study population through the database we used. In conclusion, we found a relatively low prevalence of influenza vaccination among Canadian youth and the most common reason for non-vaccination was the respondents’ belief that vaccination was not necessary. Although adolescents are not a high-risk group for severe influenza disease, when infected, they may act as vectors transmitting disease to high-risk relatives . In the wake of the H1N1 virus pandemic and the ever present threat of avian influenza, it is more imperative that public health interventions emphasize prevention, transmission reduction and vaccination.